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The ‘TEI-index’ is preload dependent and can be measured by transoesophageal echocardiography during mechanical ventilation

Published online by Cambridge University Press:  11 July 2005

J. T. Lutz ,
R. Giebler  and
J. Peters
J. T. Lutz
Affiliation:
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
R. Giebler
Affiliation:
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
J. Peters
Affiliation:
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
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Abstract

Summary

Background and objective: The Doppler-derived echocardiographic TEI-index, defined as the sum of the left ventricular isovolumic contraction and isovolumic relaxation times divided by ejection time, quantifies combined systolic and diastolic ventricular functions. The index has been proposed to be independent of arterial pressure and heart rate, implying a broad clinical usefulness. However, it is unclear whether the index is preload independent. We assessed whether and to what degree the TEI-index is altered by left ventricular loading conditions, and the feasibility of measurement by transoesophageal echocardiography during anaesthesia and mechanical ventilation.

Methods: We studied 17 anaesthetized mechanically ventilated patients with coronary artery disease during variations in left ventricular preload evoked by head-up and head-down tilt, respectively.

Results: A head-down tilt increasing left ventricular end-diastolic area from 18.8 ± 4 to 23.7 ± 4 cm2 (P < 0.05) significantly decreased the TEI-index from 0.5 ± 0.17 to 0.33 ± 0.15 (P < 0.05). In contrast, the TEI-index remained unchanged with decreased left ventricular preload (14.4 ± 3.7 cm2) during head-up tilt.

Conclusions: An increase in preload decreases the TEI-index indicating its sensitivity to acute increases in left ventricular preload. The TEI-index can be measured perioperatively by transoesophageal echocardiography.

Keywords

ECHOCARDIOGRAPHY, TRANSOESOPHAGEALVENTRICULAR FUNCTION, LEFTMYOCARDIAL CONTRACTION, diastole, systole
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 11 , November 2003 , pp. 872 - 877
Copyright
2003 European Society of Anaesthesiology

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